Journal of Trauma and Injury

  • 제27권4호
  • /
  • Pages.115-125
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  • 2014
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  • 2799-4317(pISSN)
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  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

외상 환자에서 안정화된 생체 징후에 대한 정의의 다양성: 전국적인 조사 결과

Diversity of the Definition of Stable Vital Sign in Trauma Patients: Results of a Nationwide Survey

  • 문성표 (조선대학교 의과대학 외과학교실) ;
  • 유영선 (조선대학교 의과대학 외과학교실)
  • Mun, Seong Pyo (Department of Surgery, Chosun University, School of Medicine) ;
  • Yoo, Young Sun (Department of Surgery, Chosun University, School of Medicine)
  • 투고 : 2014.07.15
  • 심사 : 2014.08.10
  • 발행 : 2014.12.31
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초록

Purpose: Stable vital signs (SVSs) are thought to be the most important criteria for successful non-operative management (NOM) of blunt spleen injury (BSI). However, a consistent definition of SVSs has been lacking. We wanted to evaluate the diversity of the definitions of SVSs by using a nationwide survey. Methods: A questionnaire regarding the definition of SVSs was sent to the trauma surgeons working at the Department of Trauma Surgery and Emergency Medicine at a level-I trauma center between October 2011 and November 2011. Data were compared using analyses of the variance, t-tests, ${\chi}^2$ tests and logistic regressions. Results: Among 201 surgeons, 198 responded (98.2%). Of these 198 responses, 45 were incomplete, so only 153 (76.1%) were analyzed. In defining the SVSs, significant diversity existed on the subjects of type of blood pressure (BP), cut-off value for hypotension, technique for measuring BP, duration of hypotension, whether or not to use the heart rate (HR) as a determinant, cut-off value of hypotension when the patient had a comorbidity or when the patient was a child. Of the 153 surgeons whose responses were analyzed, 91.5% replied that they were confused when defining SVSs. Conclusion: Confusion exists regarding how to define SVSs. Most surveyed surgeons felt that a need existed to clarify both the definition of SVSs and the use of SVSs to determine hemodynamic stability for NOM.

키워드

참고문헌

  1. Hebeler RF, Ward RE, Miller PW, Ben-Menachem Y. The management of splenic injury. J Trauma 1982; 22: 492-5. https://doi.org/10.1097/00005373-198206000-00009
  2. Cooney DR, Michalak WA, Michalak DM, Fisher JE. Comparative methods of splenic preservation. J Ped Surg 1981; 16: 327-38. https://doi.org/10.1016/S0022-3468(81)80690-2
  3. Popovsky J, Wiener SN, Felder PA, Biramje A, Reydman M. Liver trauma: conservative management and the liver scan. Arch Surg 1974; 108: 184-6. https://doi.org/10.1001/archsurg.1974.01350260040008
  4. Yoo SY, Lim KS, Kang SJ, Kim CS. Pitfalls of nonoperative management of blunt abdominal trauma in children in Korea. J Ped Surg 1996; 31: 263-6. https://doi.org/10.1016/S0022-3468(96)90011-1
  5. Fifer T, Obeid FN, Sorensen VJ, Horst HM, Bivins BA. Comparative accuracy of diagnostic peritoneal lavage, liverspleen scintigraphy, and visceral angiography in blunt abdominal trauma. Am Surg 1989; 55: 612-5.
  6. Starnes S, Klein P, Magagna L, Pomerantz R. Computed tomographic grading is useful in the selection of patients for nonoperative management of blunt injury to the spleen. Am Surg 1998; 64: 743-8.
  7. Koksal N, Uzun MA, Muftuoglu T. Hemodynamic stability is the most important factor in nonoperative management of blunt splenic trauma. Turkish J Trauma & Emerg Surg 2000; 6: 275-80.
  8. Morgenstern L, Uyeda RY. Nonoperative management of injuries of the spleen in adults. Surg Gyn & Obs 1983; 157: 513-8.
  9. Zucker K, Browns K, Rossman D, Hemingway D, Saik R. Nonoperative management of splenic trauma. Conservative or radical treatment? Arch Surg 1984; 119: 400-4. https://doi.org/10.1001/archsurg.1984.01390160036008
  10. McKenney KL, McKenney MG, Cohn SM, Compton R, Nunez DB, Dolich M, et al. Hemoperitoneum score helps determine need for therapeutic laparotomy. J Trauma 2001; 50: 650-4. https://doi.org/10.1097/00005373-200104000-00009
  11. Longo WE, Baker CC, McMillen MA, Modlin IM, Degutis LC, Zucker KA. Nonoperative management of adult blunt splenic trauma. Criteria for successful outcome. Ann Surg 1989; 210: 626-9. https://doi.org/10.1097/00000658-198911000-00010
  12. Lynch JM, Ford H, Gardner MJ, Weiner ES. Is early discharge following isolated splenic injury in the hemodynamically stable child possible? J Ped Surg 1993; 28: 1403-6. https://doi.org/10.1016/S0022-3468(05)80336-7
  13. Wasvary H, Howells G, Villalba M, Madrazo B, Bendick P, DeAngelis M, et al. Nonoperative management of adult blunt splenic trauma: a 15-year experience. Am Surg 1997; 63: 694-9.
  14. Siplovich L, Kawar B. Changes in the management of pediatric blunt splenic and hepatic injuries. J Ped Surg 1997; 32: 1464-5. https://doi.org/10.1016/S0022-3468(97)90563-7
  15. Williams MD, Young DH, Schiller WR. Trend toward nonoperative management of splenic injuries. Am J Surg 1990; 160: 588-92. https://doi.org/10.1016/S0002-9610(05)80751-2
  16. Archer LP, Rogers FB, Shackford SR. Selective nonoperative management of liver and spleen injuries in neurologically impaired adult patients. Arch Surg 1996; 131: 309-15. https://doi.org/10.1001/archsurg.1996.01430150087017
  17. Clancy TV, Weintritt DC, Ramshaw DG, Churchill MP, Covington DL, Maxwell JG. Splenic salvage in adults at a level II community hospital trauma center. Am Surg 1996; 62: 1045-9.
  18. Brasel KJ, Weigelt JA, Christians KK, Somberg LB. The value of process measures in evaluating an evidence-based guideline. Surgery 2003; 134: 605-10. https://doi.org/10.1016/S0039-6060(03)00339-8
  19. Watson GA, Rosengart MR, Zenati MS, Tsung A, Forsythe RM, Peitzman AB, et al. Nonoperative management of severe blunt splenic injury: are we getting better? J Trauma 2006; 61: 1113-8. https://doi.org/10.1097/01.ta.0000241363.97619.d6
  20. Cathey KL, Brady WJ, Jr., Butler K, Blow O, Cephas GA, Young JS. Blunt splenic trauma: characteristics of patients requiring urgent laparotomy. Am Surg 1998; 64: 450-4.
  21. Krause KR, Howells GA, Bair HA, Glover JL, Madrazo BL, Wasvary HJ, Bendick PJ. Nonoperative management of blunt splenic injury in adults 55 years and older: a twenty-year experience. Am Surg 2000; 66: 636-40.
  22. Eastridge BJ, Salinas J, McManus JG, Blackburn L, Bugler EM, Cooke WH, et al. Hypotension begins at 110 mm Hg: redefining "hypotension" with data. J Trauma 2007; 63: 291-7. https://doi.org/10.1097/TA.0b013e31809ed924
  23. Jones D, Engelke MK, Brown ST, Swanson M. A comparison of two noninvasive methods of blood pressure measurement in the triage area. J Emerg Nurs 1996; 22: 111-5. https://doi.org/10.1016/S0099-1767(96)80253-4
  24. Cienki JJ, DeLuca LA, Daniel N. The validity of emergency department triage blood pressure measurements. Aca Emerg Med 2004; 11: 237-43. https://doi.org/10.1111/j.1553-2712.2004.tb02203.x
  25. McGee S, Abernathy WB, Simel DL. Is this patient hypovolemic. JAMA 1999; 281: 1022-9. https://doi.org/10.1001/jama.281.11.1022
  26. Skirton H, Chamberlain W, Lawson C, Ryan H, Young E. A systematic review of variability and reliability of manual and automated blood pressure readings. J Clin Nurs 2011; 20: 602- 14. https://doi.org/10.1111/j.1365-2702.2010.03528.x
  27. McCann UG 2nd, Schiller HJ, Carney DE, Kilpatrick J, Gatto LA, Paskanik AM, et al. Invasive arterial BP monitoring in trauma and critical care: effect of variable transducer level, catheter access, and patient position. Chest 2001; 120: 1322-6. https://doi.org/10.1378/chest.120.4.1322
  28. Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Liver cirrhosis: an unfavorable factor for nonoperative management of blunt splenic injury. J Trauma 2003; 54: 1131-6. https://doi.org/10.1097/01.TA.0000066123.32997.BB
  29. Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery 1993; 33: 1007-16. https://doi.org/10.1227/00006123-199312000-00008
  30. McVay MR, Kokoska ER, Jackson RJ, Smith SD. Throwing out the "grade" book: management of isolated spleen and liver injury based on hemodynamic status. J Ped Surg 2008; 43: 1072-6. https://doi.org/10.1016/j.jpedsurg.2008.02.031
  31. Tataria M, Nance ML, Holmes JH 4th, Miller CC 3rd, Mattix KD, Brown RL, et al. Pediatric blunt abdominal injury: age is irrelevant and delayed operation is not detrimental. J Trauma 2007; 63: 608-14. https://doi.org/10.1097/TA.0b013e318142d2c2
  32. Bannon MP, O'Neill CM, Martin M, Ilstrup DM, Fish NM, Barrett J. Central venous oxygen saturation, arterial base deficit, and lactate concentration in trauma patients. Am Surg 1995; 61: 738-45.
  33. Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma registry of the Deutsche Gesellschaft fur unfallchirurgie. Shock 2001; 15: 83-9.
  34. Hongcheol L, Namsoo J. Korean Trauma Assessment and Treatment course 1st ed, Koonja, 2010.